CN101374465B - Ablation device and system for guiding ablation device into body - Google Patents

Abstract

A device for ablating tissue at a desired location in the body, the device comprising: a pair of floating jaws movable between spaced-apart open and closed positions, the pair of jaws including at least one ablation element for ablating tissue located between the jaws; a handle including a controller for remotely controlling movement of the jaws and the at least one ablation element; and a flexible neck connecting the jaws to the handle, wherein the neck is flexible to allow the jaws to be maneuvered relative to the handle within the body. A system for guiding the ablation device to a desired location in the body is also provided.

Description

Ablating device and the system that ablating device is guided in body

The cross reference of related application

The application requires the priority of No. the 60/762nd, 699, the U.S. Provisional Application that is entitled as " ablating device and method " submitted on January 27th, 2006, will fit into this paper in it as a reference.

The application also is combined with the content of the following U.S. Patent application that jointly awaits the reply by reference: with the application being entitled as of submitting on the same day " use the method for ablating device and ablating device guided to method (METHODS OF USING ABLATION DEVICE AND OF GUIDING ABLATIONDEVICE INTO BODY) in body " the _ _ _ _ _ _ _ _ number, the application of attorney docket MTI0053/US (P-24242.02); With with the present invention being entitled as of submitting on the same day " of the ablating device of tool locking feature (ABLATIONDEVICE WITH LOCKOUT FEATURE) _ _ _ _ _ _ _ _ number, the application of attorney docket MTI0054/US (P-24242.03).

Technical field

The present invention relates generally to treat patient tissue with ablation energy, relate more specifically to ablating device, this device has flexible shaft so that surgical operation is placed ablating device, and/or has the locking feature to help preventing from applying unintentionally ablation energy.

Background technology

Although the present invention considers to relate to device, the system and method that melts various types of organizations, particularly, the present invention will be absorbed in near the ablating device of organizing ablate cardiac tissue or heart and key feature thereof, guiding or the system of placing ablating device, and use the method for ablating device and ablating device is guided to method in body.And the present invention considers to treat various diseases with described ablating device, system and method, yet the present invention will specifically be absorbed in the treatment to arrhythmia (for example atrial fibrillation).

In normal heart, contraction and the diastole of cardiac muscle are carried out with orderly fashion, electrochemical signals is tied to chamber (AV) from right atrium antrum (SA) in order and is tied by myocardium, and then the path (comprising his-Purkinje system (His-Purkinje)) along fine restriction enters left and right ventricles.Sometimes, the atrium abnormal rhythm and pace of moving things is called atrial arrhythmia.Three kinds of modal arrhythmia are dystopy atrial tachycardia, atrial fibrillation and atrial flutter.Arrhythmia can cause obvious patient uncomfortable, even causes death because of many relevant issues, and these problems comprise: (1) irregular heart rate causes the patient not accommodate anxiety; (2) synchronous chamber shrinks and loses, and the infringement hematodinamics causes the congestive heart failure of various levels; (3) blood flow is stagnated, and has increased the liability of thromboembolism.Although it is one or more the spuious loops in a left side and/or right atrium that people be sure of main mechanism, sometimes still is difficult to point out ARR concrete pathological cause.Think that these loops or stray electrical signal will disturb from SA and tie the normal electrical chemical signal of tying and enter ventricle to AV.

ARR treatment can realize by all means, comprises medicine, surgical operation, implantable pacemaker/defibrillator and catheter ablation (catheter ablation).Although antiarrhythmic medicament can be used as many patients' treatment selection approach, these medicines only can be covered symptom and can not cure potential reason.On the other hand, implantable device usually only can be in arrhythmia generation post-equalization arrhythmia.On the contrary, surgical operation and based on the treatment of conduit usually by melting abnormal proarrhythmia tissue or causing ARR off path, in fact can cure this problem.Depend on based on the treatment of conduit target tissue is applied various destructive energy, comprise the unidirectional current energy that puts on target tissue, this unidirectional current energy comprises unidirectional current electric energy, radio-frequency electrical energy, microwave energy, laser energy, freezing energy, ultrasonic etc.

A kind of surgical method for the treatment of atrial fibrillation is " labyrinth (Maze) " operation, and the method depends on the otch pattern of regulation to produce anatomically coiling path or labyrinth, for the electric transmission that realizes in left atrium.This operation utilizes the otch in right side and atrium, left side, the atrium is divided into the electric insulation part, and this electric insulation makes partly the depolarization wave front pass through in order from sinuatrial node (SA knot) to atrioventricular node (AV knot), prevents simultaneously the propagation of the wave surface of turning back.Maze operation is very effective on the healing arrhythmia.Yet, complicated on this surgical technic.The open cardiac operation of this requirements of operation will be cut breastbone in this operation, allow the surgeon directly contact heart.

Recently, developed the method that is similar to maze operation, these methods adopt ablation catheter, and these conduits can melt kitchen range with effective generation conductivity labyrinth in predefined paths in formation on endocardium.Typically, the tissue that the electrode that is carried by conduit melts forms and melts kitchen range.Be applied to the ablation energy of electrode, for example high intensity focused ultrasound (HIFU) energy, radio frequency (RF) energy, microwave energy and/or laser energy produce significant physiological role due to heat and/or metataxis or effect in tissue.By controlling energy level, also can control the heat levels and tissue injury or the intensity of variation that produce in tissue.Ablation procedure adopts the voltage of reduced levels, and this voltage produces enough heats and causes required cell injury, but keeps organizational structure complete with the in-house electric pathway of effective blocking-up.Rinsing electrode with saline or other conductor fluids during ablative surgery can reduce interface impedance, cools tissue and can realize the larger kitchen range degree of depth that melts.

Specifically, the treatment of atrial fibrillation comprises around pulmonary vein melts, and this operation is called the pulmonary vein hole and separates.Think that nearly all atrial fibrillation signal is all from four pulmonary vein and be transferred to the atrium.Melt the pulmonary venous atrial region of connection and form annular scar tissue, the pulse that starts in the blocking-up pulmonary vein is transferred to the atrium, thereby disconnects the abnormal cardiac rate path and prevent atrial fibrillation.

Most of aforementioned ablating devices are designed to arrive heart by the center line sternotomy (being open surgery).Recently, melting of heart tissue can realize by the minimally-invasive path, for example intercostal, introduce the conduit that enters heart by the xiphoid-process lower cut or through vein.This minimally invasive surgical breaks away from pumping usually to carry out (off-pump), i.e. the intra-operative heartbeat.This operation needs several imports usually, enters heart area and performs the operation to allow medical apparatus and instruments.

Ablating device accurately need to be set in heart or near it melting of exact position in heart.Ground carries out because the reason of the physiological function of heart, the operation of exploitation especially recently generally break away from pumping, so the accurate location of ablating device is difficult especially.As mentioned above, in some cases, need tissue to peel off that Special medical equipment is guided or be passed to desired location in body.Particularly, separate for the pulmonary vein hole, usually peel off the tissue that every pair of pulmonary vein is connected to pericardial reflection, thereby be arranged on ablating device on pulmonary vein and/or around it.

Usually, if adopt the device of prior art to peel off, and if need the Special medical equipment guiding is put in place, peel off and arrange the medical apparatus and instruments of special use with device independently after peeling off.Can peel off simultaneously and arrange the device of the prior art of another kind of device (especially ablating device) and need to sew up conduit near device end or its, this device end is positioned near heart simultaneously.Sew up near pulsatile heart is dirty and have the risk that produces adverse consequences.

Near the another kind challenge that ablating device is set in heart or it is, patient's anatomical structure is different, needs different inlet points or import to obtain the path towards heart.Some existing ablating devices comprise the ablation that is connected in stiffener, and these stiffeners are difficult to be set in patient body.Operation to such stiffener is problematic, may cause tissue injury.And, if entrance or entrance location do not allow to use this stiffener to arrive the heart desired area, must prepare another import to arrive desired area.

The ablating device that is used for cardiac ablation can have the electrode in the pawl that is incorporated into the tweezers sampling device, but this device clamp and melting between pawl is organized.Usually, the controller for the ablation energy of using by electrode is positioned at external.These controllers usually are positioned on generator or switching device away from the ablating device portion of the handle.These independently controller cause the surgeon that attention is removed from the patient.In addition, these independently controller may be also that the surgeon can't touch, namely need other staff to handle these controllers.These problems about surgeon and controller nearness can cause during ablative surgery the unwanted position of patient or unwanted timing error apply ablation energy.In addition, especially for some minimally invasive surgicals, these remote controllers or switch also need to move in operating room to arrive difficult position in body when the surgeon is mobile in operation, and this is undesirable.Namely be used in the controller that activates ablation energy source and be arranged on the ablating device handle of surgeon's hands, during device operated and be set in body, ablation energy controller (for example trigger) may inadvertently be activated unwanted the time.

Therefore, need a kind of novel ablating device, ablating device is guided to the system in body and use ablating device and ablating device is guided to method in body, these devices, system and method can improve ablative surgery.Specifically, improve ablative surgery by reducing the required import volume of suitable arrival heart area.In addition, by reducing or eliminating undesirable tissue injury, for example use stiffener to send the damage that ablation causes, improve ablative surgery.And, by avoid in vivo unwanted position inadvertently the application of ablation energy improve ablative surgery.And, assign to improve ablative surgery by the handle portion that controller is navigated to surgeon's gripping.

Some existing ablating devices are described in the following discloses document, include in full its content in this paper as a reference: U.S. Patent Application Publication 2006/0009759 A1 (Christian etc.); U.S. Patent Application Publication 2006/0036236 A1 (Rothstein etc.); U.S. Patent Application Publication 2006/0020263 A1 (Rothstein etc.); With U.S. Patent Application Publication 20,06/,004 1254 A1 (Francischelli etc.).

Summary of the invention

The present invention relates to during surgery melting tissue.The present invention is particularly useful for adopting in minimally invasive surgical procedures or endoscopic procedures, for example cardiac ablation operation (for example, the lung hole separates).This device comprises one group of grip finger with ablation, and grip finger is connected in Handleset by flexible cervical region, has open and close grip finger and the controlled long-range controller that applies ablation energy in handle.Flexible cervical region in device allows grip finger, ablation can be easily motor-driven and be set to desired location in body.This device also preferably includes blocking mechanism, unless comprise that the grip finger of ablation is in the close position, this blocking mechanism prevents the application of ablation energy.Preferably, unless user unlocking mechanism, ablation energy can not be used.The present invention also preferably includes the system that needs the position of melting in body for ablating device is directed to.

The invention provides and be better than for the existing apparatus of ablation tissue and the advantage of method.One of advantage is, the different patients' of flexible characteristic permission ablating device coupling of cervical region anatomical structure.Another advantage is, adopts the ablating device with this flexible cervical region can reduce the quantity of import in the body that carries out the required preparation of ablative surgery, because use single inlet device can arrive more oversensitive dirty zone.Another advantage of the present invention is, because grip finger is in parallel configuration when make position, and because cervical region is flexible, so the pawl end of device can easily mate the small-sized port by minimally invasive surgical.The flexibility that another advantage of the present invention is cervical region makes the surgeon carry out ablative surgery in multiple path.Another advantage is, grip finger is the pawl design of floating, this unsteady pawl can with the effect mutually of organizing of multiple configuration or thickness.Another advantage is, only has be in the close position and just can apply ablation energy during user unlocking mechanism when grip finger, and this can be avoided in device is sent into physiological disposition, unwanted tissue being applied ablation energy.And the controller of device can be positioned on handle easily, and handle is gripped and controlled by user.One of advantage of system of the present invention is, the option of ablating device can be fast in conjunction with guide line system and the setting of dissociating fast to help ablating device.

First embodiment of the present invention is the device of desired location ablation tissue in vivo, this device comprises: a pair of unsteady pawl, described pawl can move between isolated open position and make position, and described a pair of pawl comprises that at least one ablation is to melt between described pawl at tissue; Handle, it comprises that controller is with the described pawl of Long-distance Control and at least one ablation; With the flexible cervical region that is connected described pawl and described handle, wherein, described cervical region is flexible, so that described pawl can be motor-driven in vivo with respect to described handle.The open position of the pawl in device is the scissor-shaped configuration, and make position is parallel configuration.The ablation of device can comprise the electrode assemblie that fluid is auxiliary.The controller of handle can comprise lever, and described lever causes pawl to move between open position and make position when motion.The controller of described at least one ablation can comprise can activate the trigger that melts power source.Handle controller can comprise the latch fitting that pawl is locked in make position.Handle controller can comprise the overload mechanism for the closure of restriction pawl.Described overload mechanism can comprise clutch pack.

Second embodiment of the present invention is the device for ablation tissue, this device comprises: a pair of unsteady pawl, described pawl can move between isolated open position and make position, described a pair of pawl comprises that at least one ablation is to melt the tissue between described pawl, the open position of described pawl is the scissor-shaped configuration, and described make position is parallel configuration; Handle, it comprises that controller is with the motion of the described pawl of Long-distance Control and described at least one ablation; And, connect the cervical region of described pawl and handle.

The 3rd embodiment of the present invention is for ablating device being directed to the system of desired location in body, this system comprises: ablating device, described ablating device has a pair of pawl, and described a pair of pawl comprises that at least one ablation is to melt the tissue between described pawl; With the device that is used for ablating device is directed to desired location, the attachable and attached described ablating device again of described device.The ablating device of described system can comprise: a pair of unsteady pawl, and described pawl can move between the open position at interval and make position, and described a pair of pawl comprises that at least one ablation is to melt the tissue between described pawl; Handle, it comprises that controller is with the motion of the described pawl of Long-distance Control and described at least one ablation; With the flexible cervical region that is connected described pawl and handle, wherein, described cervical region is flexible so that described pawl can be motor-driven in vivo with respect to handle.The structure that is used for the guiding ablating device can comprise at least one guiding elements, and described guiding elements comprises the conduit that is connected in attachment, described attachment can with the pawl of ablating device on the attachment synergism.

Description of drawings

Further explain the present invention in connection with accompanying drawing, the similar similar numeral of structure in institute's drawings attached, wherein:

Fig. 1 is the plane graph according to ablation system of the present invention, has shown ablating device, the first and second guiding elements and guiding elements adapter.

Fig. 2 is the plane graph according to a kind of embodiment of the part of ablating device claw assembly part of the present invention.

Fig. 3 is the top view according to a kind of embodiment of ablating device claw assembly part of the present invention, shows that claw assembly is shown in an open position, and has shown leading edge parts and pogo barrel holding member in the mode of wire frame or dotted line.

Fig. 4 is claw assembly same as shown in Figure 3, and just claw assembly is in than comparatively closed position shown in Figure 3, and two pawls are parallel to each other.

Fig. 5 is according to claw assembly part of the present invention, the cervical region that is connected in the claw assembly part and the plane graph of power and fluid delivery pipeline.

Fig. 6 is the decomposition view of Fig. 5.

Fig. 7 is the close-up illustration of the claw assembly part of Fig. 6.

Fig. 8 is the plane graph according to a kind of embodiment of the part of ablating device handle portion of the present invention, wherein is shown as one of two halfbodies removing handle casing with the exposed handle internal part, and bracing wire extends proximally in handle.

Fig. 9 is the side view according to a kind of embodiment of ablating device handle portion of the present invention, wherein is shown as one of two halfbodies removing handle casing with the exposed handle internal part, and has the cervical region that is attached to handle.

Figure 10 is the side view according to clutch pack of the present invention.

Figure 11 is the plane graph of the clutch pack of Figure 10.

Figure 12 is the exploded view of the clutch pack of Figure 10 and 11.

Figure 13 is Figure 10 and 11 clutch packs from the another kind of exploded view of the favourable angle that is different from Figure 12.

Figure 14 is the exploded view of the lever segment (and attachment member) according to Handleset of the present invention.

Figure 15 is the plane graph according to a kind of embodiment of the part of ablating device handle portion of the present invention, wherein is shown as one of two halfbodies removing handle casing with the exposed handle internal part, and has the cervical region that is attached to handle.

Figure 16 is the plane graph according to some parts of blocking mechanism of the present invention.

Figure 17 is the another kind of plane graph from Figure 16 blocking mechanism same parts of another favourable angle.

Figure 18 is the exploded view of each parts of blocking mechanism of Figure 17.

Figure 19 is the profile of the part of Handleset, show that pawl activates lever and is in latched position, and the locking characteristic solution removes.

Figure 20 is the profile of the Handleset same section of Figure 19, shows that pawl activates lever and discharges, and the locking feature activation.

Figure 21 is the profile according to a kind of embodiment of the part of ablating device handle portion of the present invention, wherein is shown as one of two halfbodies removing handle casing with the exposed handle internal part, comprises power line and fluid delivery pipeline.

Figure 22 is the side view according to cord of the present invention (cord) assembly.

Figure 23 is the side view according to a kind of embodiment of ablating device claw assembly part of the present invention, shows that the part of the claw assembly that comprises grip finger is crooked.

Figure 24 is the side view according to a kind of embodiment of ablating device claw assembly part of the present invention, shows that the part of the claw assembly that comprises grip finger is crooked.

Figure 25 is heart side plane figure, is presented in the lung hole separation process that causes the boxlike kitchen range, and two ablating devices are around two pairs of pulmonary vein closures.

Figure 26 is heart side plane figure, is presented in the lung hole separation process that causes the rotary island kitchen range, and two ablating devices are around two pairs of pulmonary vein closures.

Figure 27 is the schematic diagram (showing with respect to heart) of the orifices of pulmonary veins of looking from the health front side, comprises the pulmonary vein pair in right side and left side.

Figure 28 is the schematic diagram of the orifices of pulmonary veins of Figure 27, shows the method step that guides and use ablating device according to the present invention, and wherein the first guiding elements inserts a rear side on the [Dan vein.

Figure 29 is similar to Figure 28, shows the subsequent step of described method, wherein the second guiding elements is inserted the lower rear side of [Dan vein.

Figure 30 is similar to Figure 29, shows the subsequent step of described method, wherein shows, according to the present invention, ablating device is attached to the first and second guiding elements.

Figure 31 is the plane graph according to the part of ablating device grip finger distal tube shade assembly of the present invention, shows to separate with the end of guiding elements of the present invention.

Figure 32 is similar to Figure 31, shows in the method the step with the end portion insertion tube shade assembly mouth of guiding elements.

Figure 33 is similar to Figure 32, shows the subsequent step of the method, wherein, and in the end portion insertion tube shade assembly mouth of guiding elements.

Figure 34 is the plane graph that divides according to the shroud assembly on ablating device grip finger far-end of the present invention and guiding elements end, shows in the method the step with guiding elements insertion tube shade assembly.

Figure 35 is similar to Figure 30, shows the subsequent step of the method, wherein, ablating device is pulled to around the right position of right lung vein.

Figure 36 is similar to Figure 35, shows the subsequent step of the method, and wherein, after melting, ablating device is shown in an open position and shows and melts kitchen range.

Figure 37 is similar to Figure 36, shows the subsequent step of the method, and wherein, ablating device withdraws from.

Figure 38 is according to claw assembly of the present invention and guiding elements end top view, show that guiding elements is connected in a grip finger of claw assembly, arrow represents that guiding elements moves the direction to remove from grip finger, and this step is to remove the step of guiding elements in method from grip finger.

Figure 39 is similar to Figure 38, shows the subsequent step of the method, wherein, guiding elements towards the grip finger medial movement to remove guiding elements.

Figure 40 is similar to Figure 39, shows the subsequent step of the method, and wherein, guiding elements is removed from grip finger.

Figure 41 is similar to Figure 40, shows the subsequent step of the method, and wherein, ablating device is removed from guiding elements.

Figure 42 is similar to Figure 41, shows the subsequent step of the method, and wherein, ablating device is attached to the two ends from two guiding elements of previous step.

Figure 43 is similar to Figure 42, shows the subsequent step of the method, wherein, ablating device is pulled to around the right ablation locations of left pulmonary vein.

Figure 44 is similar to Figure 43, shows the subsequent step of the method, wherein, melts rear ablating device and is shown in an open position and shows and melt kitchen range.

Figure 45 is similar to Figure 44, shows the subsequent step of the method, and wherein, ablating device withdraws from.

Figure 46 is similar to Figure 45, shows the orifices of pulmonary veins that obtains after the method previous step, melts kitchen range with two.

Figure 47 is the schematic diagram (showing with respect to heart) of the orifices of pulmonary veins of looking from the health front side, comprises the pulmonary vein pair in right side and left side, demonstrates the step in the method, and in this step, the far-end of dissector/guiding piece is around right lung vein pair.

Figure 48 is the plane graph according to the guiding elements end of insertion guiding elements adapter of the present invention, as shown by arrows.

Figure 49 is the plane graph that is connected in the guiding elements of guiding elements adapter according to of the present invention.

Figure 50 is similar to Figure 49, shows the subsequent step of the method, shows that wherein the guiding elements with the guiding elements adapter is attached to the far-end of dissector/guiding piece.

Figure 51 is similar to Figure 50, shows the subsequent step of the method, wherein, takes out dissector/guiding piece and guiding elements is pulled to around right lung vein pair.

Figure 52 is similar to Figure 51, shows the subsequent step of the method, and wherein, dissector/guiding piece is removed from guiding elements.

Figure 53 is similar to Figure 52, shows the subsequent step of the method, and wherein, ablating device according to the present invention is attached to guiding elements.

Figure 54 is similar to Figure 53, shows the subsequent step of the method, wherein, ablating device is pulled to around the right ablation locations of right lung vein.

Figure 55 is similar to Figure 54, shows the subsequent step of the method, and wherein, ablating device is shown in an open position and shows and melts kitchen range after melting.

Figure 56 is similar to Figure 55, shows the subsequent step of the method, and wherein, guiding elements and ablating device withdraw from.

Figure 57 is similar to Figure 56, shows the subsequent step of the method, and wherein, dissector/guiding piece is configured to far-end around left pulmonary vein pair.

Figure 58 is similar to Figure 57, shows the subsequent step of the method, wherein, shows the far-end that is attached to dissector/guiding piece with the guiding elements of guiding elements adapter.

Figure 59 is similar to Figure 58, shows the subsequent step of the method, and wherein, dissector/guiding piece withdraws from and guiding elements is pulled to around left pulmonary vein pair.

Figure 60 is similar to Figure 59, shows the subsequent step of the method, wherein, dissector/guiding piece is removed from guiding elements.

Figure 61 is similar to Figure 60, shows the subsequent step of the method, and wherein, ablating device according to the present invention is attached to guiding elements.

Figure 62 is similar to Figure 61, shows the subsequent step of the method, wherein, ablating device is pulled to around the right ablation locations of left pulmonary vein.

Figure 63 is similar to Figure 62, shows the subsequent step of the method, and wherein, ablating device is shown in an open position and shows and melts kitchen range after melting.

Figure 64 is similar to Figure 63, shows the subsequent step of the method, and wherein, guiding elements and ablating device withdraw from.

The specific embodiment

In detailed description of the preferred embodiment, with reference to accompanying drawing, these accompanying drawings are parts of this description, set forth enforcement the specific embodiment of the present invention in the mode of example below.Should be understood that and also can adopt other embodiments and carry out structure or logistic transformation and do not deviate from scope of the present invention.Therefore, following specific descriptions should not be construed as restrictive implication, and scope of the present invention is limited by appended claims.

With reference to accompanying drawing, ablating device, ablation system and using method thereof are described, disclosed and mentioned to the similar similar numeral of parts in institute's drawings attached by a plurality of embodiments, is used for the purpose of ablation tissue in subject.Should be understood that according to any ablating device of the present invention, system and method to be applicable to any position in subject, comprise applicable human body or other animals or the biology that melts.The below is described as the present invention to develop for ablate cardiac tissue, and separates and the treatment of atrial fibrillation in particular for the pulmonary vein hole, as described in this paper background parts.However, it should be understood that ablating device, system and method can be used for treating any disease of applicable ablation of tissue.

The device that the present invention considers preferably includes for the basic function of certain position ablation tissue in vivo.This device preferably includes: make the grip finger that comprises ablation easily operate and be set to the means of desired location in body.In addition, this device preferably includes the means that prevent that ablation energy from applying, unless grip finger (comprising ablation) is in the close position and user is removed the mechanism of the ablation energy source of stopping using.And this device preferably includes the controller of next-door neighbour's user, and more preferably controller is positioned on the device portion of the handle.And this device can be device to be directed to the part of the system of certain position in body.This optimum system choosing comprises that at least one guiding elements is attached, break away from, again be attached to possibly the means of ablating device, to help ablating device being guided to desired location in body.

At first with reference to figure 1, show exemplary ablation system 10, comprised exemplary ablating device 12.This ablation system 10 also comprises at least one guiding elements (being depicted as the first and second guiding elements 14,16) and optional guiding elements adapter 18.Ablating device 12 can use separately or unite use with one or two guiding elements 14,16, and guiding elements is attachable or be connected in ablating device 12, ablating device 12 is drawn to the desired location that melts.Guiding elements 14,16 also preferably can be attached or be connected in ablating device or other devices, breaks away from and then attached from this device.shown in guiding elements adapter 18 can use and be attached to one of guiding elements 14 or 16 in case guiding device (for example, U.S. Patent Application Serial Number _ _ _ _ _ _ _ _, _ _ _ _ _ _ _ _, be entitled as " surgery is peeled off and/or other medical apparatus and instruments are guided to device and system (DEVICE ANDSYSTEM FOR SURGICAL DISSECTION AND/OR GUIDANCE OF OTHERMEDICAL DEVICES INTO BODY) in body " and be entitled as " surgery is peeled off and/or other medical apparatus and instruments are directed to method (METHOD OF SURGICAL DISSECTION AND/OR GUIDANCE OFOTHER MEDICAL DEVICES Th1T0 BODY) in body ", attorney docket is respectively MTI0049/US (P-22921.02) and MTI0052/US (P-22921.O3), these two parts of applications and the application submit on the same day, jointly await the reply) guide or arrange ablating device 12, thereby (for example carry out ablative surgery, Figure 26, shown in 47-66, as described below).

The illustrative embodiments of ablating device 12 shown in Figure 1 generally includes: claw assembly 20, the cord assembly 26 that claw assembly 20 is connected in the flexible cervical region 22 of Handleset 24 and is attached to Handleset 24.The below will describe major part and all parts thereof of ablating device 12 in detail.

In order to melt required tissue, the claw assembly 20 with ablating device 12 before melting keeps or the clamp tissue.Fig. 2 has shown the plane graph of the part of claw assembly 20.Shown in claw assembly 20 parts comprise a pair ofly originally each other for the grip finger of mirror image (right 28a, left 28b), when they are in the close position, allow claw assembly 20 clamp tissues.Fig. 2 also is included in the shroud assembly 30 of each pawl 28a, 28b far-end, forms to make guiding elements attached or break away from the mechanism (detailed content of guiding elements is as described below) of two pawl 28a, 28b far-end.In addition, Fig. 2 also comprises exterior region 32, the miscellaneous part that wherein holds and be assembled with the near-end of pawl 28a, 28b and be used for open and close pawl 28a, 28b.Also shown the pawl back-moving spring sleeve pipe 33 on a part that is positioned at exterior region 32 in Fig. 2.

Fig. 2 shows that also pawl 28a, 28b are preferably crooked, and other shapes are also possible.The purpose of bending shown in Figure 2 is, allows pawl 28a, 28b to mate around some anatomical features (for example blood vessel), and with respect to this anatomical features at desired location clamp tissue.

For clamp and release tissue, pawl 28a, the 28b of claw assembly 20 preferably moves between open position (as Figure 1-3) and make position.In order to move between the open and close position, claw assembly 20 preferably includes parts as shown in Figure 3.Fig. 3 has shown the top view of claw assembly 20 preferred implementations, has shown exterior region 32 and pawl back-moving spring sleeve pipe 33 with the form of wire frame or dotted line.Preferably, claw assembly 20 each parts are configured to as pawl 28a, when 28b begins closure, and motion is pivotable or scissors-like, but when 28a, 28b are further mutually close, pawl 28a, 28b are finally closed with parallel configuration, as shown in the part make position of Fig. 4 median claw 28a, 28b." scissor-shaped " refers to that the orientation of two pawls is angled each other, as the pivotal point that leaves when pawl 28a, 28b are in open position roughly.When pawl 28a, 28b begin closed and continue mutually near motion, their extraordinary image shears such mutual pivotable of motion until move to be parallel to each other certain a bit.By pawl 28a, 28b are finally convergeed to together with the configuration of almost parallel, pawl 28a, 28b all tissue contact side basically contacted with tissue in about identical time, contacted the length of side and applied organizationally the more power of homogeneous along the tissue of pawl 28a, 28b.And, closed or when being closed together as pawl 28a, 28b, their limited angles of preferably can floating each other, in order to contact inhomogenous tissue surface, as further described below.

Pawl 28a, 28b movable and can closed (namely approaching) and the purpose of opening be clamp and discharge tissue to be melted, as mentioned above.Yet another purposes that pawl 20 is approached are, make to be in the size and dimension of the claw assembly 20 of make position roughly can pass 12 millimeters of patients or other sizes during minimally invasive surgical procedures trocar import.

Claw assembly 20 preferably is configured to pawl 28a, 28b can compensate the difference of organizing configuration or thickness.The design of claw assembly 20 is constructed such that preferably pawl 28a, 28b are closed in the mode of independent floating.Specifically, the claw assembly 20 that floats allows as pawl 28a, 28b when roughly contacting along the tissue of its length, the tissue that pawl 28a, 28b can the clamp different-thickness.For example, thicker tissue can be thinner organizes more near exterior region 32, and pawl 28a, 28b can not stay open because of thick tissue, but closed and along its length contact tissue.

Be used for the position of controller of clamp and ablation tissue away from pawl 28a, 28b, be preferably placed in Handleset 24, Handleset 24 is preferably hand-held.Fig. 5 has shown by cervical region 22 from Handleset 24 to remote extension to the parts of claw assembly 20, in order to the clamp in each parts of control claw assembly 20 and claw assembly 20 and cervical region 22 with melt.In illustrative embodiments shown in Figure 5, two power lines 34 (for example, radio frequency (RF) line) and the bracing wires 35 of tangling with two fluid delivery pipelines 36 (for example saline delivery pipeline) by cervical region 22 from the parts that Handleset 24 extends to claw assembly 20.Fig. 6 is the exploded view of all parts of preferred ablating device 12 parts shown in Figure 5.Fig. 7 is the close-up illustration of claw assembly 20 considerable parts of decomposition shown in Figure 6.With reference to figure 5-7, all parts of preferred implementation shown in the below will describe in detail.However, it should be understood that described embodiment is preferred, the present invention also considers other versions, comprises in other modes known or that developed starting and/or controlling ablating device, can comprise some described parts and/or other parts of not describing.

With reference to figure 5-7, from claw assembly 10, the preferred claw assembly 20 of the present invention comprises two pawl 28a, 28b, and each pawl 28a, 28b comprise respectively a shell 38a, 38b.The purpose of shell 38a, 38b is, holds the parts (as described below) of the contiguous pawl 28a of needs, 28b and ablation tissue.Shell 38a, 38b preferably are made of electrically insulating material, comprise at least two passages, each passage longitudinal extension, the first passage 40a on each pawl 28a, 28b be mutually in the face of with therebetween tissue of contact, the second channel 40b in each shell 38a, 38b mutually back to.Provide pawl arm 42a, 42b with in the second channel 40b that matches pawl shell 38a, 38b.Pawl arm 42a, 42b are shown as remaining in shell 38a, 38b by the electric insulation covering 44a, the 44b that locate in shell 38a, 38b.But pawl arm 42a, 42b controlled motion also are operably connected with shell 38a, 38b, with other claw assembly 20 means of attachment to realize the controlled motion of pawl 28a, 28b.Pawl arm 42a, 42b comprise elongated portion 46a, the 46b in the second channel 40b that remains on respectively pawl shell 38a, 38b.And as shown in Figure 7, pawl arm 42a, 42b preferably include fluting 48a, 48b, their contiguous elongated portion 46a, 46b, and, because fluting 48a, 48b be to proximal extension, so they tilt towards the contact side of organizing of claw assembly 20 inside or pawl 28a, 28b.Pawl arm 42a, 42b also preferably include respectively pin 50a, the 50b at each pawl arm 42a, 42b near-end separately, shown in orientation, to downward-extension, pin 50b extends upward on left arm 42b pin 50a on right arm 42a.Miscellaneous part synergism in fluting 48a, the 48b of pawl arm 42a, 42b and pin 50a, 50b and claw assembly 20 is to open or closed pawl 28a, 28b, and is as described below.

For ablation tissue, preferably provide fluid auxiliary slender electrode assembly in the passage 40a of each shell 38a, 38b.This electrode assemblie preferably includes elongated tubular product electrode 52a, 52b, and elongated tubular product electrode 52a, 52b remain in passage 40a, then is preferably located in the tube chamber of porous electrode holder 54a, 54b.Preferably, elongated tubular product electrode 52a, 52b comprise array of fluid import (not shown), these imports are fluid passage (not shown) opening and towards the tissue contact surface of each pawl 28a, 28b orientation internally, make conductor fluid to disperse by the array of fluid import from electrode 52a, 52b, then the duct by porous electrode holder 54a, 54b and around its periphery lateral migration is with thoroughly and equably along right pawl and left pawl 28a, 28b moistening porous electrode holder 54a, 54b.Preferably by independently fluid delivery pipeline 36a, 36b provide conductor fluid (for example saline) (end portion that has only shown fluid delivery pipeline 36a, 36b in Fig. 7) to each electrode 52a, 52b.

Elongated tubular product electrode 52a, 52b are preferably formed by the thin-walled that extends between open proximal 56a, 56b and closed distal 58a, 58b, ductile stainless steel pipe.Fluid inlet for example extends laser drill from the inner and preferred single line of tube chamber and forms the array of fluid import by pipe material inner wall, although can form any selected array around the tubing sidewall periphery. Electrode support substrate 54a, 54b preferably include porous polymer such as Porex ^TMPlastics.

Elongated tubular product electrode 52a, 52b are flat electrodes, and flat electrode is preferred, because flat design can apply to the tissue surface that needs melt more multi-energy.But the present invention has also considered electrode or the ablation of other types and shape.Other possible ablation are the energy transfer elements that transfer the energy to target tissue.For example, energy can be conductive element, and it provides RF energy (as shown in the figure), HIFU energy, microwave energy, heat energy, freezing energy or ultrasonic energy to target tissue.Energy transfer element can be for example that the laser diode of laser is provided to target tissue.Two or more energy transfer elements or conductive element can bipolar form be arranged (as shown in the figure), and wherein, at least one element is used as anelectrode, and at least one element is used as negative electrode.One or more energy transfer elements of ablating device 12 or conductive element can the one pole form be arranged, wherein at least one element is as an electrode, and silent electrode is positioned at other positions of patient body-surface such as back, shank or shoulder or other positions except ablating device 12 positions.

Energy transfer element or conductive element can comprise one or more conductive of material or blend, comprise titanium, titanium alloy, TiNi alloy, marmem, superelastic alloy, aluminium oxide, platinum, platinum alloy, rustless steel, stainless steel alloy, MP35N, elgiloy, Hai Ensi 25 (haynes 25), associated mineral (satellite), RESEARCH OF PYROCARBON, silver-colored carbon, conducting metal, conducting polymer or plastics and/or conductivity ceramics.Energy transfer element or conductive element can be non-conductive, but as the pipeline of sending conductive material such as conductor fluid.Energy shifts or conductive element can be porous.For example, energy transfer element or conductive element can comprise porous polymer, metal or pottery.Coating coating energy transfer element or the conductive element of available non-stick coating such as PTFE or other types described herein.Specifically, energy transfer element can comprise one or more coatings, for example hydrophilic coating.Energy transfer element or conductive element can be flexible, should allow them to conform to the surface of target tissue.Energy transfer element or conductive element can be toughness, allow thus the surgeon to adjust its shape to adapt to the target tissue surface.

Energy transfer element or conductive element can comprise coil or the conduction Web materials in one or more metallic conductors such as polymer.Energy transfer element or conductive element can comprise the conduit for delivery of fluids.This conduit can comprise hole or fluting.Polymeric catheter can be set in metal catheter to control fluid delivery by energy transfer element or conductive element.One or more energy transfer elements or conductive element can be used as one or more Neural stimulation electrodes and/or are used as one or more heart stimulating electrodes.Electrode can be used for cardiac pacing, defibrillation, conversion, induction, stimulation and/or mapping.

Energy transfer element or conductive element can comprise pin, and it is designed to piercing tissue such as fat and muscle.For example, energy transfer element or conductive element can be designed to pierce through the fat on heart, make energy transfer element or conductive element can arrive heart tissue.Pin allows fluid (as conductor fluid), chemicals (as melting chemical substance), medicine, biological reagent and/or cell to pass through.Pin allows vacuum or suction to pass through.

In other embodiments, ablating device 12 of the present invention can comprise the structure for the position of following the trail of ablating device 12.The structure of tracking ablating device 12 positions for example can comprise, sensor and imaging device.An example of this tracking structure is described in U.S. Patent Application Publication US 2006/0229594 A1 people such as () Francischelli, will fit into this paper in it as a reference.

Can apply binding agent so that elongated tubular product electrode 52a, 52b and porous electrode holder 54a, 54b are maintained in the passage 40a of pawl shell 38a, 38b.Adhesive therefor can not blocked conductor fluid around the migration of porous electrode holder 54a, 54b.

In order to provide energy or power to elongated tubular product electrode 52a, 52b, in preferred embodiment, power line 34 is from power supply (preferably being independent of ablating device 12) to remote extension by cervical region 22 and be soldered to elongated tubular product electrode 52a, 52b, (part that has only shown power line 34 in Fig. 7) as shown in Figure 7, preferably electrode 52a, 52b not by electrode support substrate 54a, 54b the parcel the position.

In addition to the above methods, the present invention has also considered to rinse the additive method of electrode or ablation.The purpose of rinsing electrode with saline or other conductor fluids is to help to reduce interface impedance, cools tissue and realize the larger kitchen range degree of depth that melts.Flushing helps also to prevent that tissue or fat from stopping up electrode, helps to keep electrode clean.

Fig. 6 and 7 has shown with pawl arm 42a, the synergistic miscellaneous part of 42b to approach pawl 28a, 28b.Two halfbody 32a, 32b having shown exterior region 32 in figure.As shown in the figure, the halved body of exterior region preferably is of similar shape, and is configured to mate as shown in the figure or link together, and holds be used to the parts that approach.As shown in Figure 7, two identical pin 60a, 60b are arranged between halved body 32a, the 32b of exterior region 32 and attached with it.Fluting 48a on pawl arm 42a remains on pin 60a slidably, and fluting 48b remains on pawl arm 42b slidably.Pin 50a, 50b on pawl arm 42a, 42b remains in triangle open mouth 62a, the 62b of hook 64 tops and bottom movingly, and hook 64 remains in exterior region 32 movingly.Pin 50a, 50b on pawl arm 42a, 42b also remains in opening 51a, the 51b of halved body 32a, 32b of exterior region movingly.The near-end of hook 64 is attached to bracing wire 35.Bracing wire 35 keeps barb 66 to proximal extension by distal neck from linking up with 64, distal neck keeps barb to be attached to exterior region halved body 32a, 32b by extension 68a, the 68b of its far-end, because extension 68a, 68b can mate in hole 70a, 70b on exterior region halved body 32a, 32b.It is to make cervical region 22 be attached to exterior region 32 that distal neck keeps the purpose of barb 66, makes when cervical region 22 and exterior region 32 operationally are fixed together, and bracing wire 35 is moved with respect to cervical region 22 and exterior region 32.

For at the closed pawl 28a of open position, 28b, from installing 12 proximal part tractive bracing wire 35 (how to operate with hereinafter about more detailed description the content of handle portion 24), this moves hook 64 to near-end in the shaping inner chamber of exterior region 32.When linking up with 64 when drawing to near-end, it applies power on pawl arm 42a, 42b, and pawl arm 42a, 42b are connected with hook 64 by pin 50a, 50b.When pawl arm 42a, 42b interior during to an initial distance of near-end traction at exterior region 32, fluting 48a, 48b slide along pin 60a, 60b exterior region 32 is interior, make pawl 28a, 28b mutually close in the scissors-like motion mode, pin 60a, 60b are positioned at the intermediate point place of fluting 48a, 48b.At this moment, the control of the shape by fluting 48a, 48b and make preferably almost parallel of pawl 28a, 28b with the interaction of pin 60a, 60b.In case pawl 28a, 28b almost parallel (but not yet closed) further will make pawl 28a, 28b also further to the near-end tractive to the near-end tractive on hook 64.Pin 50a, 50b extend through fluting 62a, the 62b in hook 64, and fluting 51a, the 51b in exterior region halved body 32a, 32b passed in guiding.When bracing wire 35 is further moved to near-end with respect to cervical region 22 and exterior region 32, thereby the shape of fluting 51a, 51b forces pin 50a, 50b to make pawl 28a, 28b mutually close.Simultaneously, the width of fluting 62a, the 62b of hook 64 allows pin 50a, 50b to move inward.And pin 60a, 60b slide along fluting 48a, 48b.The combination of pin 50a, 50b and 60a, 60b and fluting 48a, 48b and 51a, 51b interaction makes pawl 28a, 28b mutually close until pawl 28a, 28b are in roughly closed position (being in contact with one another) with the position of almost parallel.Fluting 51a, 51b also can limit hook 64 in the interior degree that moves to near-end of exterior region 32.This arrangement of pin and fluting also allows pawl 28a, 28b to float to pin and the degree that fluting interacts and to allow, and makes to come based on the counteracting force that is applied to the pawl surface with engage tissue the orientation relative to each other of adjustable claw 28a, 28b.

Bracing wire 35 is passed cervical region 22 from handle portion 24, keeps the inner chamber in barb 66 to extend to claw assembly 20 by distal neck.Fig. 6 shows, bracing wire 35 by incompressible coil 72b around, coil 72 again by sleeve pipe 72a institute around.The preferred material of sleeve pipe 72a is polyimides, although also considered other materials.The purpose of sleeve pipe 72a is, with bracing wire 35 tractives during by claw assembly 20 each element and parts crooked and protection bracing wire 35 when moving around in flexible cervical region 22.Preferably, as shown in Figure 6, power line 34 and fluid delivery pipeline 36 also coiled coil pass through cervical region 22 to alleviate strain.

In order to make pawl 28a, 28b return to open position from make position, claw assembly 20 comprises pawl back-moving spring 74 (referring to Fig. 6) (doing the used time generation without tension force in bracing wire 35).Fig. 6 also shows, pawl back-moving spring 74 preferably is held to encircle 76 appropriate locations that remain on around exterior region 32 at its near-end, and this provides biasing with to far-end moveable hook 64 between exterior region 32 ends and hook 64.Spring 74 is set to and links up with 64 and contact, and the power along distal direction of applying on hook 64 is so that pawl arm 42a, 42b return to open position.Also as shown in Figure 6, pawl back-moving spring sleeve pipe 78 covers pawl back-moving spring 74 and retaining ring 76.Other biasings of the miscellaneous part that the present invention has also considered also to make pawl 28a, 28b return to open position and/or configuration arrange.

Bracing wire 35 is passed cervical region 22 from claw assembly 20 and is extended proximally into handle 24 in device 12.When bracing wire 35 enters handle 24, bracing wire 35 is passed the near-end cervical region and is kept barb 80 (as shown in Figure 6), the near-end cervical region keeps barb 80 that cervical region 22 is attached to Handleset 24, and bracing wire 35 continues to extend into Handleset 24 and is attached to bracing wire terminal 82 (also as shown in Figure 6) at its far-end.With holding screw 84, bracing wire terminal 82 is fixed on appropriate location in handle 24 (Fig. 6).

Bracing wire 35 preferably is made of rustless steel, although also can use other suitable materials, uses the solid disk coiling around bracing wire 35.The preferred configuration of bracing wire 35 and wound coil is incompressible coil.The present invention has also considered to be suitable as other suitable materials and/or the design of incompressible coil.One of purpose of incompressible coil configuration is, the part of passing flexible cervical region 22 when bracing wire 35 bends or keeps the total length of bracing wire 35 during distortion.

Claw assembly 20 is connected in Handleset 24 by cervical region 22 functions.The purpose of cervical region 22 is to provide bar axle or the inner chamber that parts (for example power line 34, fluid delivery pipeline 36 and bracing wire 35) can be extended through between claw assembly 24 and Handleset 24.The length of cervical region 22 is preferably relevant to the operation required separation distance, and Handleset 24 is positioned at (namely external) outside health so that claw assembly 20 is positioned at required anatomical location.

The cervical region 22 that connects claw assembly 20 and handle 24 is preferably flexibility or " soft ".For example, in one embodiment, cervical region 22 is soft as rope.Therefore, flexible or " soft " property makes it possible to use guiding elements or device easily claw assembly 20 settings of ablating device 12 to be put in place with ablation tissue.The flexibility of cervical region 22 makes ablating device 12 be applicable to many different anatomical structure in different patients.Cervical region 22 is transmitting torque effectively.

Preferably, cervical region 22 is made of the extruding polyurethane of 304 rustless steel braidings.Yet the present invention has also considered to provide other suitable parts or the design of cervical region 22 required flexibilities.

For the application with ablation energy of approaching of control claw 28a, 28b, these two processes are approached and are preferably placed at external with ablation controller all near claw assembly 20 places of ablating device 12 or its, preferably occur when claw assembly 20 is set up in vivo desired location.Preferably, controller be arranged in Handleset 24 and/or on, Handleset 24 is positioned at external during ablative surgery.Preferably, Handleset 24 comprises handle casing 86, and handle casing 86 has the handle casing halfbody (wherein a halfbody is as shown in the 86a in Fig. 8) of two couplings, is used for holding miscellaneous part and provides handpiece for the user of device.And preferably, Handleset 24 is held in the hands of user.

As mentioned above, for making claw assembly 20 each members close pawl 28a, 28b, the controller in use Handleset 24 is to near-end tractive bracing wire 35.In general, with reference to figure 8 and 9, for to near-end tractive bracing wire 35, by the user extruding or to handle casing 86a (only having shown half) moving jaws activation lever 122, cause synergistic various connected components to be coordinated with controllably moving to near-end tractive bracing wire 35.Handleset 24 also comprises to be made bracing wire 35 remain on proximal location and can reverse component movement to discharge bracing wire 35 and the parts of opening pawl 28a, 28b.

Shown in accompanying drawing preferred embodiment in, especially in Fig. 8 and 9, bracing wire 35 is passed the near-end cervical region and is kept barb 80 to extend into handle casing 86 from cervical region 22, is connected in bracing wire terminal 82.Preferably, use holding screw 84 with bracing wire terminal 82 fix in position.Preferably (there is a recess end of bracing wire terminal 82 with the recess of two halfbody 86a that remain on shell 86,86b (not shown) in handle casing halfbody 86a, as shown in the 89a in Fig. 8,15) in two rollers 88 be connected, make roller 88 rotations and provide predetermined path for roller 88.Bracing wire terminal 82 also pass pitman arm 92 far-ends in 90, the size and shape in hole 90 can keep bracing wire terminal 82.

Generally, the basic role of clutch pack 94 be with pawl activate lever 122 near shell 86 and the motion that deviates from shell 86 be separately converted to pitman arm 92 roughly to the motion of near-end and far-end.Then, pitman arm 92 makes bracing wire 35 to near-end with to distal movement, and is closed or open pawl 28a, 28b respectively.

As shown in Fig. 8-13, clutch pack 94 preferably includes pitman arm 92 usually, pitman arm 92 is connected in bracing wire 35 and is attached to the miscellaneous part of clutch pack 94, the miscellaneous part of described clutch pack 94 is around axle 110 pivotables and be attached to cam 104, and cam 104 can rotate by the motion that pawl activates lever 122.Clutch pack also preferably includes the parts (namely comprise transship the parts of mechanism) of common permission overload slide plate, thereby, in case when making pawl 28a, 28b around tissue closure with certain power, pawl activates lever 122 can be continued to push that towards the cam 104 of shell 86 and rotation lever 122 is locked in the appropriate location, and can not cause extra further the approaching to near-end tractive or pawl 28a, 28b of bracing wire 35.Clutch pack 94 also preferably includes governing mechanism of tension, regulates tension force in overload slide plate to adapt to the different ablation tissue thickness for the treatment of by this mechanism.

More particularly, with respect to all parts of clutch pack 94, for closed pawl 28a, 28b,, simultaneously bracing wire terminal 82 is pulled in recess (one of them is 89a) to near-end to near-end tractive bracing wire 35 by pitman arm 92.Roller 88 and attached bracing wire terminal 82 are rotated in recess (one of them is 89a), simultaneously the pitman arm 92 of clutch pack 94 to the purpose that near-end moves is roughly, prevent the bracing wire 35 in crank handle assembly 24, pass when entering claw assembly 20 from cervical region 22 when bracing wire that this can cause bracing wire 35 tensionings and fracture.

Specifically, Figure 10-13 shows, clutch pack 94 comprises pitman arm 92, pitman arm 92 distal attachments are in bracing wire terminal 82 (as mentioned above), and near-end uses pin 98 and clamp ring 100 (Figure 13) to be attached to clutch 96, pin 98 (Figure 12,13) extends through the hole 102 of suitable size and shape on pitman arm 92 and the hole (not shown) on clutch 96, and these two holes are co-axially aligns.The purpose of clutch 96 is mobile link arms 92, and pitman arm 92 moves bracing wire 35.Clutch 96 preferably also is attached to clutch (or torsion) spring 106 (as shown in Fig. 8-13).Preferably, rotor 108 is attached to the clutch spring 106 of clutch 96 offsides, and rotor 108 comprises that screw 112 and anchor 114 are to regulate the tension force in clutch spring 106.Cam 104 is attached to rotor 108.As shown in the figure, cam 104 comprises fluting 124, and pawl activates lever 122 and remains on movably in fluting 124.Axle 110 passes the hole in clutch 96, cam 104 and rotor 108, with another clamp ring 100, axle 110 is held in place.

Can be by tightening or loosening the tension force that screw 112 and anchor 114 are regulated clutch spring 106.Specifically, in the accompanying drawing illustrated embodiment, tighten screw 112 and will make clutch spring 106 coilings tighter.

With reference to figure 8,9 and 14, Handleset 24 comprises that also pawl activates (or closed) lever 122, and it comprises extension 136, and extension 136 is attached to the cam 104 of clutch pack 94 movingly.Shown in extension 136 exemplary attached of lever 122 be to complete around roller 126 (Figure 14) coupling in extension 136 by the fluting 124 that makes cam 104, roller 126 be arranged in the groove 128 of extension 136 of lever 122 and be fixed on the appropriate location with the pin 130 that passes two holes 134 in hole 132 and extension 136, described hole is co-axially align.Then the roller 126 of pawl activation lever 122 can roll along the fluting 124 in cam 104, and both are moved mutually with predefined paths, keeps simultaneously movable connection.Lever 122 is around point 121 pivotables, and lever 122 is attached to handle casing 86 at this some place.The preferred ergonomics of lever 122 is shaped the person's of being used in conjunction with hands.

In order to activate or closed pawl 28a, 28b, extrusion lever 122 or it is moved towards shell 86.Shift lever 122 causes the extension 136 of lever 122 to move into handle casing 86 by this way, make the counterclockwise pivotable of cam 104 (as shown in Fig. 8,9), make the counterclockwise pivotable of clutch 96 (as shown in Fig. 8,9) by clutch pack 94 each parts.As a result, clutch 96 is roughly to near-end tractive pitman arm 92, and bracing wire terminal 82 moves to near-end along the recess in handle casing 86a, 86b (one of them is 89a) path.Therefore, the bracing wire 35 that is attached to bracing wire terminal 82 is entered Handleset 24 to the near-end tractive, thereby closed pawl 28a, 28b.Figure 15 has shown the position of handle 24 parts when pawl 28a, 28b are in make position roughly.

Pawl 28a, when 28b is in the close position, Handleset 24 each parts are similar to Figure 15 substantially.If further apply power (being about to lever 122 upwards puies forward or further push towards shell 86) on lever 122, above-mentioned overload slide plate can prevent from applying more tension force in bracing wire 35.Yet preferably, lever 122 is moved further so that lever 122 lockings are in place towards handle casing 86, then pawl 28a, 28b is locked in locked position of coupler.In case pawl 28a, 28b are locked in make position, locking feature of the present invention lost efficacy, thereby allowed to apply ablation energy.This locking feature will be described in more detail below.

Above-mentioned pawl close mechanism is an example of this mechanism.The present invention also considers, pawl 28a, 28b can be driven by mechanical mechanism (for example driving rope or the line in wedging ring), hydraulic mechanism (for example fluid pressure provides the piston of power) and/or electronic mechanism (for example servomotor).Above-mentioned each pawl close mechanism can be shown in an open position and/or allow during make position cervical region 22 to keep flexible or soft at pawl 28a, 28b.

In the present invention, ablating device 12 preferably includes the mechanism that prevents from inadvertently applying ablation energy, is called blocking mechanism or feature.For fear of inadvertently melting, preferably in Handleset 24 in conjunction with blocking mechanism.An example of this blocking mechanism is included in embodiment as shown in Fig. 8,9 and 15, and by preventing that ablation energy source is activated to work, unless pawl 28a, 28b are locked in roughly make position.

Before pawl 28a, 28b were locked in make position, some parts of the Handleset 24 in exemplary means 12 can prevent applying of ablation energy.Specifically, exemplary embodiment prevents applying of ablation energy by preventing the trigger 140 on pulling device 12.The mechanism that prevents trigger 140 to be pulled and apply ablation energy can be described as blocking mechanism.Shown in blocking mechanism, on preferred trigger 140 or range estimation and/or sense of touch locking sign 142 near it, this sign is indicated when closedown structure engagement or is activated.When blocking mechanism is activated, locking sign 142 extends through the hole in trigger 140, and visible or feel on trigger 140, in case lost efficacy, the locking sign is absorbed in the hole of trigger 140.

The miscellaneous part of visible exemplary blocking mechanism in Figure 16-18 respectively.These parts are parts that power triggers sub-component 138, and described sub-component comprises trigger 140, and trigger 140 is attached to locking sign 142 by pin 144 pivotables.Locking sign 142 is by fluting 149 (Figure 18) and to be connected in the pin 148 of slide closure 150 attached.Passage 145 with the breach 143 of slide block 150 both sides and guide rail 152 both sides remains in locking guide rail 152 slide closure 150 slidably, breach 143 can slide in passage 145, and the spring 154 between guide rail 142 and slide block 150 makes them separate at the near-end that power triggers sub-component 138.And, at the near-end of guide rail 152, extension or tail spare 156 being arranged, it can press power switch to open ablation energy source.

Power triggers sub-component and is combined in the remainder of Handleset 24, as shown in Fig. 8,9 and 15.Make trigger 140 also can be connected in two handle casing halfbodies (one of them halfbody is shown as 86a) with respect to the pin 144 of locking sign 142 pivotables.And the protuberance 147 in guide rail 152 outsides is connected in two shell halfbodies (one of them is 86a), makes guide rail or to tilt with respect to shell (wherein half is shown as 86a) rotation.Therefore, these parts roughly allow slide block 160 to move to near-end with to far-end in being attached to the guide rail of handle casing.Slide block 150 is retracted in trigger 140 sign 142 to near-end tractive locking sign 142, allows trigger 140 to rotate freely around pin 144.When trigger 140 can rotate freely around pin 144, it can be drawn out or press so that sliding piece 150 on trigger 140, cause thus guide rail 152 around protuberance 147 pivotables or rotation, make extension on guide rail 152 or tail spare 156 apply pressure on power switch 164 and activate the application of ablation energy.In case discharge trigger 140, torsion spring pushes away for 162 times on guide rail 152, guide rail 152 is around protuberance 147 pivotables or rotation.This just causes slide block to push away on trigger 140 for 150 times, and trigger 140 will be around pin 144 rotation, thus the pressure that makes extension on guide rail 152 or tail spare 156 discharge on power switchs 164, and then stop the application of ablation energy.

For slide block 150 is moved so that blocking mechanism lost efficacy to near-end, with reference to figure 8 and 15, the extension 136 that pawl activates lever 122 passes fluting 151 (when lever 122 is squeezed) in slide block 150 until the proximal end face 153 of fluting 151 in proximal end face 137 contact slippers 150 of extension 136, slide block 150 is moved to near-end with respect to guide rail 152, and to near-end tractive locking sign 142, locking feature 142 is absorbed in trigger 140 thus.

When locking sign 142 fully is absorbed in and when pressing trigger 140, lever 122 also locks onto in handle casing (wherein half is 86a).In the embodiment of example shown, ratchet 158 is attached to handle casing (wherein half is 86a) and extends through fluting 151 in slide block 150.Ratchet 158 near-ends are attached extension spring 160 also.When extension 136 moves into handle casings (wherein half is 86a), when ratchet 158 was caught projection 196 on extension 136, lever 122 may be locked in extrusion position, as shown in the profile of Figure 19.When ratchet 158 is caught projection 196, and blocking mechanism lost efficacy as described above, can press trigger 140, make guide rail 152 pivotables, thereby the extension 156 on guide rail 152 pressed power switch 164.Power switch 164 preferably is connected in power supply, and position of source is preferably away from Handleset 24.

For release piece activates lever 122, open pawl 28a, 28b on claw assembly 20, reactivate blocking mechanism, the lever release-push 192 (Figure 14) that is positioned on lever 122 is pressed, pushes or otherwise moves into lever 122 to near-end.The profile of the part of handle portion 24 shows that lever release-push 192 promotes ratchet 158 to near-end and makes it no longer catch the mechanism of the projection 196 rear generations on lever 122 as shown in 20.As a result, ratchet 158 is promoted to near-end and release piece activation lever 122.Pawl activates lever 122 and leaves subsequently shell (wherein half is 86a), and pawl 28a, 28b can open.The distal face 135 of extension 136 keeps contacting with the distal face 157 of slide block 150, and drives slide block 150 to far-end, promotes locking sign 142 and makes slide block around the axis pivotable of pin 144.As a result, locking sign 142 extends through the hole 146 in trigger 140.Shown in preferred embodiment in, user is indicated in being positioned at visually with in sense of touch of locking sign 146, blocking mechanism meshes, ablation energy can not apply.

Shown in mentioned above and accompanying drawing, blocking mechanism is an example of this mechanism, and it can prevent that undesirable position applies ablation energy carelessly in vivo.The present invention has also considered to prevent in vivo careless or unexpected other blocking mechanisms that apply ablation energy in undesirable position.For example, consider to control blocking mechanism by the feedback of installing, especially installing the sensor of any amount on pawl.These sensors can for example be responded to the whether required tissue of clamp of pawl, then make blocking mechanism lose efficacy and open or close ablation energy.The present invention has considered spendable any suitable feedback mechanism in the blocking mechanism.

In order to provide power and fluid to the preferred auxiliary slender electrode assembly of fluid as the part of ablating device 12, power line 34 and fluid delivery pipeline 36 need to be extended through Handleset 24, cervical region 22 from power supply and fluid source, and enter claw assembly 20.The preferred path that power line 34 and fluid delivery pipeline 36 pass cervical region 22 and claw assembly 20 has above been described.In Handleset 24, the preferred path of power line 34 and fluid delivery pipeline 36 shows in Figure 21.As shown in figure 21, two handle halfbodies (only having shown 86a) can have a series of inner vertical walls that extend laterally 168, inwall 168 can comprise fluting and/or recess, is used for arranging power line 34 and fluid delivery pipeline 36 and the extensible handle casing 86 that passes of inwall 168.Power line 34 and fluid delivery pipeline 36 be from the near-end of Handleset 24 far-end of arranging, and passes the near-end cervical region and keep hole in barb 80, continues to march to cervical region 22 and claw assembly 20

Power supply and fluid source are preferably away from ablating device 12.As shown in Figure 1, cord assembly 26 is attached to Handleset 24, provides power and fluid by cord assembly 26.In cord assembly 26, power supply supply cord 172 keeps power line 34, and fluid supply cord 170 keeps fluid delivery pipeline 36.

Figure 22 has shown the cord assembly 26 of removing after cord 170, a part of 172.It provides the close-up illustration of fluid and mains connection.As shown in the figure, preferred fluid cord 170 and the fluid source of connecting of fluid connector 174.Cloudy connector 174 is cloudy screwed pipe (luer) preferably, as shown in the figure.Fluid source can be standard I V conduit system.In addition, ablating device preferably includes for amount and the mechanism that applies or the device of controlling fluid, thereby suitably applies fluid to realize auxiliary the melting of fluid.Figure 22 has also shown mains connection 176, preferably connects power supply cord 172 and power supply.Shown in and described cord assembly 26 and all parts be exemplary, the present invention has also considered to send to Handleset 24 other suitable alternative of power and fluid.

Ablating device 12 can be combined with one or more switches in order to regulated one or more parts or the feature of ablating device 12 by the operator.For example, one or more switch controls are to the flush fluid of ablating device 12 claw assemblies 20 and/or the supply of ablation energy.Described one or more switch can be for example hand switch, foot switch and/or comprise the audio-switch of voice recognition technology.Described one or more switch can be combined on the handle 24 of ablating device 12 and/or in.

Shown in accompanying drawing preferred embodiment in, on and off switch 164 (for example RF switch) is included in (Fig. 9) in Handleset 24.For on and off switch power supply, and in order to activate or inactive remote power supplies from and off switch 164, preferred one group of electric wire 166 extends from switch 164 near-end that passes Handleset 24, arrives power supply.Figure 21 has shown some exemplary electric wires 166 of drawing from and off switch 164, and these electric wires pass power supply cord 172 to proximal extension and arrive power supply.

Although demonstration in figure, ablating device 12 can comprise one or more sensors or sensing element and monitor one or more parts or feature.For example, preferably, ablating device 12 can be monitored the saturating wall that melts kitchen range.An example for the optimization algorithm of monitoring wall is described in the temporary patent application the 60/832nd, 242 that jointly awaits the reply, and includes in full its content in this paper as a reference.

Above-mentioned ablating device 12 preferably is used for ablating device 12 is directed to the part of the system 10 (Fig. 1) of desired area in body.The miscellaneous part of this system 10 can comprise the first and second guiding elements 14,16 and guiding elements adapter 18.About guiding elements 14,16 and the detailed description of guiding elements adapter 18 hereinafter the using method and ablating device 12 being directed in the method for suitable position in body of ablating device 12 describe.

As ablating device 12 being directed to the part of the system 10 of desired area in body, ablating device can have the different claw assemblies 20 that are attached to device 12 cervical regions 22.Pawl 28a, 28b that the different claw assembly 20 that specifically, can provide in this system 10 can have different curvature or shape.Purpose with so different claw assemblies is to adapt to the different anatomic degree to put the different ablative surgeries that carry out, and the different anatomic feature that adapts to individual patient.Figure 23 and 24 has shown the side view of 20 two kinds of different embodiments of claw assembly of the present invention.These two kinds of exemplary embodiments have shown grip finger 28a, the 28b with different curvature.As mentioned above, the purpose of different curvature is to adapt to different ablative surgeries.For example, grip finger 28a, the 28b of embodiment shown in Figure 23 (only having shown 28b) preferably is applicable to the boxlike kitchen range method that the lung hole separates, (on heart 174) as shown in figure 25.And the curvature of grip finger 28a, the 28b of embodiment shown in Figure 24 (only having shown 28b) preferably is applicable to the rotary island kitchen range method that the lung hole separates, as shown in figure 26 greater than shown in Figure 23.Rotary island kitchen range method (Figure 26) adopts the larger grip finger 28a of curvature, the purpose of 28b to be, allows grip finger 28a, 28b are set to the tissue that begins to locate near pulmonary vein end and left atrium.Hereinafter in the method part, boxlike kitchen range and rotary island kitchen range method will be described in more detail.In Figure 25 and 26, although show two groups of grip finger 28a, 28b around two groups of pulmonary vein or clamp or closure in its vicinity, preferably break away from the pumping situation at heart and do not carry out simultaneously.Usually, once only melt one group of pulmonary vein, thereby do not block the pulmonary vein of another group.

Ablating device 12 and/or system 10 are used in the body that needs ablation tissue and carry out ablative surgery in each position.Specifically, ablating device 12 is applicable to the lung hole with system 10 and separates.As mentioned above, exist different lung holes to separate surgical operation.With reference to figure 27-64, boxlike kitchen range that according to the present invention ablating device 12 and/or system 10 separate at the lung hole and the detailed content of the application in rotary island kitchen range method are provided.Figure 27-30,35-37,41-47,50-64 are schematic expressions, may be also incorrect or disproportionate on anatomical structure.These figure are in order to help to understand method of the present invention.

Figure 27-46 have shown the step in the method for using ablating device 12 and/or guiding ablating device 12, and the shell operation is the operation of boxlike kitchen range.Figure 27 has schematically shown the orifices of pulmonary veins 176 of looking from health and heart rear side.Orifices of pulmonary veins 176 comprises two groups of pulmonary vein, right 180 and left 178.Figure 28 has shown a step in the method that guides and use ablating device 12 according to the present invention, wherein, the first member 14 is inserted a rear side on the [Dan veins.For example, guiding elements 14 can pass otch by minimally invasive surgical.Need four otch or import in operation, allow to lead to orifices of pulmonary veins 176 from four direction.In this step and any other steps hereinafter described, can adopt any known or technology in the future exploitation and/or device that guiding elements is arranged on a rear side on the [Dan vein.Figure 29 shows the subsequent step of described method, wherein, the second guiding elements 16 is inserted the lower rear side of [Dan vein.Figure 30 has shown another subsequent step, wherein, ablating device 12 at two distal attachments of pawl 28a, 28b in the one 14 and the 2 16 guiding elements.

For example, guiding elements 14,16 or the device can comprise one section list or many inner chambers pipeline.Can comprise that positive guide connects, described positive guide connects and comprises the connecting elements that is positioned at guiding elements 14, one or more ends of 16 or install 216, for example ball-and-socket coupling, screwed pipe coupling and/or stitching is between the distal portions that is connected to ablating device (shroud 30).Guiding elements 14,16 can comprise the reference mark of indicated depth or length reference value.Guiding elements 14 or 16 can comprise two or more length of pipes, each independently the pipeline sections can color coding in order to mutually distinguish.In one embodiment, if the cervical region 22 of ablating device 12 is loose or soft, for example user can not initiatively push or thrust tissue with pawl 28a, 28b, thereby cause undesirable tissue injury, can use guiding elements 14 or 16 that pawl 28a, the 28b of ablating device 12 are pulled to the appropriate location safely.Guiding elements 14 or 16 can comprise one or more blunt nosed.Guiding elements 14 or 16 can comprise suture at its far-end.Fig. 1 comprises that two ends have the guiding elements 14,16 of suture 15.Suture can be any suitable suture material.The purpose of suture is, makes another device (for example tweezers) can easily grasp the suture of guiding elements 14 or 16 ends, and guiding elements 14 or 16 is pulled to the desired position.And guiding elements 14 or 16 can comprise wire skeleton and positive guide connector.

For the first and second guiding elements 14,16 are attached to the pawl 28a of ablating device 12, the far-end of 28b, can use attachment mechanism, for example shown in Figure 31-33.Figure 31 has shown the far-end of pawl, is called shroud 30.The end of guiding elements 14 comprises barb 15, is shown as matching in the socket 31 of shroud in Figure 32.Preferably, when guiding elements 14 or 16 and socket angled and motor-driven in the socket time, barb can match in socket 31.Figure 33 has shown final connection configuration.Figure 34 has shown the shroud 30 of another kind of embodiment, wherein, provides the covering 33 of shroud 30.The purpose of shroud 30 is that ablating device 12 and guiding elements 14 tractives during by health, are being prevented that other elements of agnail 15 and shroud from catching tissue.

Figure 35 has shown the subsequent step of described method, wherein, ablating device 12 tractives is put in place, and pawl 20 is around left of pulmonary vein 178.By tractive guiding elements 14,16 end, ablating device 12 tractives are put in place, the end that is pulled is positioned at the attached end offside that ablating device 12 is arranged, and tractive passes otch or the import on right side of body.Next step that does not show is that the pawl 28a, the 28b clamp that make ablating device 12 organized around and activated ablation energy and melt with realization.Figure 36 has shown subsequent step, and wherein, pawl 28a, 28b open, as seen around around the left pulmonary vein to 178 melt kitchen range 182.As shown in figure 37, next step is to regain ablating device 12 from health.Guiding elements 14 and 16 is still attached.In order to remove guiding elements 14,16, can use the method shown in Figure 38-40.As shown in Figure 38-40, guiding elements 14 can be towards pawl 28a, 28b medial movement, as shown in the arrow of Figure 38.Guiding elements 14 move inward or a certain angle that tilts after, take off guiding elements 14 in the time of can be from shroud 30.Figure 41 has shown the subsequent step after removal ablating device 12, and wherein, guiding elements 14,16 is got back to its original position, stays to melt kitchen range 182.Then repeat to melt left side two pulmonary venous steps (Figure 42-45) in the left side of orifices of pulmonary veins 176, result is that orifices of pulmonary veins has two overlapping kitchen ranges 182,184 that melt, as shown in figure 46.

Figure 49 has shown the step in the method for using ablating device 12 and guiding ablating devices 12 with dissector/guiding piece 186, and this surgical operation is the operation of rotary island kitchen range.The first step of the method is with the otch entrance (but also can be used for open surgery) of dissector/guiding piece 186 insertion minimally invasive surgicals.A kind of exemplary preferred embodiment the U.S. Patent application that jointly awaits the reply of submitting on the same day with the present invention the _ _ _ _ _ _ _ _ number in describe, this application is entitled as and " is used for surgery dissecting and/or other medical apparatus and instruments are directed to device and system (DEVICEAND SYSTEM FOR SURGICAL DISSECTION AND/OR GUIDANCE OF OTHERMEDICAL DEVICES INTO BODY) in body; attorney docket MTI0049/US (P-22921.02), include in full its content in this paper as a reference.Figure 47 has shown that the joint is connected to the left pulmonary vein to the dissector/guiding piece 186 around 178.Described in above-mentioned patent application of jointly awaiting the reply, guide line can be carried by dissector/guiding piece 186, from passing to another otch or import for an import that penetrates dissector/guiding piece 186.Then, guide line is attached to guiding elements 14, guide line is withdrawed from by dissector/guiding piece 186, but this tractive guiding elements 14 contacts its far-end with dissector/guiding piece 186, as shown in figure 50.In system 10 of the present invention, guiding elements can have the guiding elements adapter 18 that is attached to guiding elements 14 ends, is used for attached guide line.In Figure 48-49, shown the guide line adapter, guiding elements 14 inserts in guiding elements adapter 18, makes guide line be attached to guiding elements 14 (by adapter 18).Next step wherein, is removed dissector/guiding piece 186 and attached guiding elements is pulled to around pulmonary venous desired location, as shown in the figure through entrance as shown in Figure 51.In next step, take off dissector/guiding piece 186 from guiding elements 14, guiding elements 14 is stayed appropriate location (Figure 52).Next step, as shown in Figure 53, ablating device 12 is connected with guiding elements 14 by its a grip finger 28a.Then, by tractive guiding elements 14, ablating device 12 is pulled to around the position of pulmonary vein 178.Pawl 28a, 28b are closed and apply ablation energy and melt kitchen range 188 with formation, the Figure 55 after opening referring to pawl 28a, 28b.After removing guiding elements 14 and ablating device 12, stay in the left side of orifices of pulmonary veins 176 and melt kitchen range (Figure 56).

Then repeat to melt the pulmonary venous step in two, right side (Figure 57-63) on the right side 176 of orifices of pulmonary veins, result is that orifices of pulmonary veins has two and melts kitchen range 188,190, as shown in Figure 64.

Ablation system 10 and parts thereof preferably are made of biocompatible materials, for example rustless steel, biocompatibility epoxide or biocompatible plastic.Preferably, the patient body anaphylaxis that biocompatible materials excites is minimum, is positioned at patient body anticorrosive.And, biocompatible materials preferably can not cause any other patient stress, for example, any element in the surgery cavity of can detrimentally not swiping.

It will be understood by those skilled in the art that, although described the present invention in conjunction with the specific embodiment and embodiment, the present invention is not limited to this, many other embodiments, embodiment, application, revises and the form that deviates from these embodiments, embodiment and application all is included in the appended claims limited range.Each patent that this paper quotes and the full content of publication are included in this in the reference mode, are included in herein independently of one another as these patents or publication.

Claims (8)

1. A device for ablating tissue at a desired location in the body, said device comprising: a pair of floating jaws movable between spaced apart open and closed positions, the pair of jaws including at least one ablation element for ablating tissue located between the jaws; a handle including a controller for remotely controlling movement of the jaws and the at least one ablation element; and a flexible neck connecting the jaws to the handle, wherein the neck is flexible to allow in vivo maneuvering of the jaws relative to the handle, and the neck is soft so as to allow Sufficient flexibility remains along the length of the neck so that the jaws cannot be actively pushed or pierced into tissue. 2. The device of claim 1, wherein the open position of the jaws is a scissor-like configuration and the closed position is a parallel configuration. 3. The device of claim 1, wherein the ablation element comprises a fluid assisted electrode assembly. 4. The device of claim 1, wherein said handle control includes a lever that moves said jaw between said open position and said closed position when moved. 5. The apparatus of claim 1, wherein the controller for the at least one ablation element includes a trigger capable of activating an ablation power source. 6. The device of claim 1, wherein the control of the handle includes a lock that locks the pawl in the closed position. 7. The device of claim 1, wherein the control of the handle includes an overload mechanism that limits the closure of the jaws. 8. The apparatus of claim 7, wherein the overload mechanism comprises a clutch pack.

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